[1]张超,姚晨,沈计荣.微创髓芯减压打压支撑植骨术结合补肾活血汤口服治疗ARCOⅡ、Ⅲ期股骨头坏死的近期疗效观察[J].中医正骨,2016,28(03):20-23.
　ZHANG Chao,YAO Chen,SHEN Jirong.[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(03):20-23.
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微创髓芯减压打压支撑植骨术结合补肾活血汤口服治疗ARCOⅡ、Ⅲ期股骨头坏死的近期疗效观察()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年03期
页码:
20-23
栏目:
骨科微创技术
出版日期:
2016-03-20

文章信息/Info

Title:
作者:
张超; 姚晨; 沈计荣
江苏省中医院,江苏 南京 210029
Author(s):
ZHANG Chao; YAO Chen; SHEN Jirong
Jiangshu Hospital of Traditional Chinese Medicine,Jiangshu 210029,Nanjing,China
关键词:
股骨头坏死;  补肾活血汤;  减压术; 外科;  骨移植;  治疗; 临床研究性
Keywords:
femur head necrosis;  Bushen Huoxue Tang;  decompression; surgical bone transplantation;  therapies; investigational
摘要:
目的:观察微创髓芯减压打压支撑植骨术结合补肾活血汤口服治疗ARCOⅡ、Ⅲ期股骨头坏死(osteonecrosis of the femoral head,ONFH)的近期疗效。方法:将符合要求的61例91髋ARCOⅡ、Ⅲ期ONFH患者随机分为2组,联合治疗组32例47髋、手术治疗组29例44髋。2组均行微创髓芯减压、死骨清理、打压植骨、异体腓骨支撑术。联合治疗组在术后第3天开始服用补肾活血汤,每天1剂,连续服用6个月。采用陈卫衡教授制定的影像学评价标准,利用X线片评定患者治疗后股骨头形态的稳定性,同时采用Harris髋关节功能评分量表评定髋关节功能。结果:治疗后12个月,按照陈卫衡教授制定的影像学标准评定,联合治疗组稳定39髋、加重8髋,手术治疗组稳定36髋、加重8髋; 2组患者股骨头形态稳定性比较,差异无统计学意义(Z=-0.145,P=0.885)。治疗前2组患者的Harris评分比较,差异无统计学意义(t=4.629,P=0.190); 治疗后12个月2组患者的Harris评分均增加[(69.97±5.77)分,(89.00±2.70)分,t=19.965,P=0.000;(69.09±5.02)分,(85.84±2.93)分,t=18.654,P=0.000],联合治疗组的评分高于手术治疗组(t=5.355,P=0.000)。结论:微创髓芯减压打压支撑植骨术在短期内可有效防止ARCOⅡ、Ⅲ期ONFH患者股骨头塌陷,配合口服补肾活血汤则更有利于患者关节功能恢复。
Abstract:
Objective:To observe the short-term clinical curative effect of minimally invasive core decompression combined with impaction bone grafting and oral application of Bushen Huoxue Tang(补肾活血汤,BSHXT)in the treatment of ARCO phaseⅡandⅢosteonecrosis of the femoral head(ONFH).Methods:Sixty-one patients(91 hips)with ARCO phaseⅡandⅢphase ONFH were enrolled in the study and were randomly divided into 2 groups,32 cases(47 hips)in combination therapy group,29 cases(44 hips)in operation group.The patients in the 2 groups were treated with minimally invasive core decompression,debridement of sequestrum,impaction bone grafting and support with allogeneic fibula.Moreover,the patients in the combination therapy group were treated with oral application of BSHXT since the third day after the operation,one dose a day for 6 consecutive weeks.The morphological stability of the femoral head were evaluated after the treatment according to radiographic evaluation criterion made by professor CHEN Weiheng,meanwhile,hip functions were evaluated by using Harris hip function scale.Results:According to the radiographic evaluation criterion made by professor CHEN Weiheng,39 hips got good stability and 8 hips got poor stability in combination therapy group,while 36 hips got good stability and 8 hips got poor stability in operation group at 12 months after the treatment.There was no statistical difference in the morphological stability of the femoral head between the 2 groups(Z=-0.145,P=0.885).There was no statistical difference in Harris scores between the 2 groups before treatment(t=4.629,P=0.190).Harris scores increased in both of the 2 groups at 12 months after the treatment(69.97+/-5.77 vs 89.00+/-2.70 points,t=19.965,P=0.000; 69.09+/-5.02 vs 85.84+/-2.93 points,t=18.654,P=0.000).Harris scores were higher in combination therapy group compared to operation group(t=5.355,P=0.000).Conclusion:Minimally invasive core decompression combined with impaction bone grafting can effectively prevent the collapse of femoral head of patients with ARCO phaseⅡandⅢONFH,and additional oral application of BSHXT is conducive to hip functional rehabilitation.

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备注/Memo

备注/Memo:
基金项目:江苏省南京市科技局项目(201303044)
通讯作者:沈计荣 E-mail:joint66118@sina.com
更新日期/Last Update: 2016-03-30